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Frameworks and Tools for Translating Research

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Overview Terminology Common barriers to research translation The RE-AIM framework Diffusion of Innovation theory The dissemination/utilization process (Glasgow ... – PowerPoint PPT presentation

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Title: Frameworks and Tools for Translating Research


1
Frameworks and Tools for Translating Research
  • Mary Altpeter, UNC Institute on Aging

IOA Seminar February 26, 2009
2
Overview
  • Terminology
  • Common barriers to research translation
  • The RE-AIM framework
  • Diffusion of Innovation theory
  • The dissemination/utilization process

3
Terminology
  • research finding new knowledge innovation
  • (e.g., new understanding of determinants, new
    method, new intervention, new tool)
  • knowledge transformation process of
    synthesizing and summarizing for application
  • for future research or translation into practical
    application
  • by researchers, clinicians, community providers
    and/or policy-makers, patients, their caregivers

4
Barriers to Research Translation Researchers
issues
  • present studies in ways that are incomprehensible
    and irrelevant to end-users
  • disseminate findings ineffectively, resulting in
    a scattershot approach for transfer of
    knowledge
  • give little attention to knowledge transfer
    because it is often not funded or is the least
    funded activity of a research project

5
Barriers to Research Translation Innovation
issues
  • insufficiently compelling to overcome the
    influence of prior experiences, beliefs, and
    habits, and practice policies, and the inertia of
    complex systems of care in local environments
  • derived in settings that are not congruent with
    the realities of clinical or community practice

6
Barriers to Research Translation Practitioners
issues
  • do not have sufficient scientific literacy and
    statistical skills to read research
  • lack self-efficacy, have low outcome expectancies
    and limited organizational support to use
    research

7
REAIM Framework, Diffusion of Innovation Theory,
Dissemination Process
  • address the barriers in the knowledge
    transformation process
  • guide researchers through a systematic process of
    communicating findings that will be relevant to
  • ongoing research about mechanisms and
    interventions
  • clinical and community provider practice in real
    world settings
  • patient and caregiver decision-making and health
    behaviors in every day life and
  • related health care policies
  • Ultimately, can help accelerate knowledge transfer

8
PURPOSES OF RE-AIM FRAMEWORK
  • Focus on impact of research efforts
  • Broaden the criteria used to evaluate programs to
    include external validity
  • Evaluate issues relevant to program adoption,
    implementation, and sustainability
  • Help close the gap between research studies and
    practice by
  • Informing design of interventions
  • Providing guides for adoptees
  • Suggesting standard reporting criteria

(Glasgow, 1999, 2000, 2004, 2006)
9
RE-AIM components
10
What is REACH?
  • Focuses on the population you want to address
    the end-users
  • Children, adults, older adults
  • Families, spouses
  • Caregivers
  • Clinicians
  • Service providers
  • Policy-makers
  • Researchers
  • Others?

11
Why is REACH important?
  • Focuses on Representativeness
  • Am I reaching the right population?
  • Which/how many individuals need to learn about my
    innovation?
  • What are their characteristics that are important
    to know about them (income, education, ethnic
    group, etc)?
  • How much training/intervention do they need?

12
Why is EFFECTIVNESS important?
  • Focuses on impact
  • Am I providing individual-level health benefits
    related to behaviors, attitudes and/or improving
    quality of life?
  • Am I improving practice or policies?
  • Am I unintentionally causing negative
    consequences or harm?
  • What are the costs?

13
Why is ADOPTION important?
  • Focuses on the middle-man - staffing,
    partnering organizations and settings where the
    innovation/intervention can be offered
  • Can partners help support my intervention/translat
    ion efforts?
  • Are partners representative of the target
    population characteristics Im trying to reach?
  • Are partner settings appropriate and accessible
    for who I want to reach?

14
Why is IMPLEMENTATION important?
  • Focuses on consistency (fidelity) of
    innovation/intervention delivery no matter how
    often its delivered
  • By clinicians and community partners
  • By patients and caregivers
  • By program administrators and policy makers
  • Across settings

15
Strategies to Assure Implementation Fidelity
  • Articulation of essential factors
  • Written guidelines
  • Training
  • Observation to monitor for compliance
  • Consultations about intervention challenges or
    changes
  • Plan for implementation setbacks

16
Balancing Fidelity and Adaptation
  • Identify essential innovation/intervention
    elements
  • Consider how approach may need to differ for
    different groups
  • Employ cultural/age /gender appropriate examples

17
Why is MAINTENANCE important?
  • Focuses on sustaining individual-level benefits
    participants (older adults, caregivers,
    clinicians) experience AND
  • Focuses on sustaining the program-level
    innovation/intervention over the long-run
  • Monitors impact on the health issue at the
    population level

18
How To Sustain Efforts
  • Follow-up with target population to gauge
    satisfaction
  • Follow-up with staff and community partners to
    learn challenges, opportunities and successes

19
Website http//re-aim.org
20
Rogers Diffusion of Innovation
  • Diffusion is the process by which an innovation
    is communicated through certain channels over
    time among the members of a social system"
    (Rogers, 2003).
  • Innovations spread through society, first by
    acceptance of early adopters followed by the
    majority, until the innovation is commonly
    accepted.
  • Framework for identifying key attributes and
    factors of innovations/transformative knowledge

21
8 Key Attributes of A New Innovation That Affect
the Rate of Adoption
  • Whether the innovation entails
  • communicability can be clearly described and
    communicated
  • relative advantage perceived as superior to
    existing practice and more beneficial than other
    alternatives
  • complexity is easy to implement
  • compatibility fits well within the existing
    environment and prior experiences and values of
    the adopter
  • (Rogers, 1962 Rogers, 1986 Rogers, 2003)

22
8 Key Attributes of A New Innovation That Affect
the Rate of Adoption
  • Whether the innovation entails
  • revisability can be customized to fit
    individual needs and contexts
  • trialability an interested researcher,
    practitioner, patient or caregiver can use the
    innovation on a trial basis
  • observability results can be easily measured
    and readily observed
  • reversibility - can be easily discontinued if it
    is deemed to be not working
  • (Rogers, 1962 Rogers, 1986 Rogers, 2003).

23
Moderators of Adoption and Implementation
  • whether there is minimal risk
  • commitment of time and costs
  • support for implementation
  • presence of a champion
  • previous success or failures with adoption of
    innovations
  • (Rogers, 1962 Rogers, 1986 Rogers, 2003)

24
Dissemination/Utilization
  • By contrast to diffusion, dissemination refers to
    the specific steps of actively facilitating
    widespread adoption (Rogers, 2003).
  • Steps
  • clearly identify who will be adopting the new
    findings (e.g., other researchers, clinicians,
    community service providers, patients,
    caregivers)
  • define what opportunities exist for reaching
    adopters
  • provide essential information about new findings
    including relevance to practice, every day life
    or research
  • strategize specific ways to build awareness about
    the new findings.

25
Dissemination/Utilization 4 Key questions
  • To whom do I disseminate my research findings?
  • What level of learning and application do I want
    to impart to knowledge users?
  • In what manner and through what channels do I
    disseminate my research findings?
  • How can I accelerate this process?

26
Dissemination/Utilization For what aim?
4Es
  • Increase knowledge
  • provide exposure to new knowledge/innovation
  • Increase knowledge and attitudes
  • provide experiences with new knowledge/innovation
    (e.g., new assessment tool)
  • Increase competence
  • develop expertise in application of new knowledge
    (e.g., building patient skills in symptom
    recognition and management),
  • Increase utilization over time
  • embed new knowledge into daily clinical practice
    or policy or patient behavior

(Farkas et al, 2003).
27
Dissemination/Utilization Approaches
  • Researchers
  • Exposure articles, seminars, emails/listservs,
    web-based information
  • Experience mentorship, curricula
  • Expertise internship, training manuals
  • Embedding - ongoing research funding and
    technical assistance

28
Dissemination/Utilization Approaches
  • Service Providers/Administrators/Policy-makers
  • Exposure - conferences, popular/professional
    media, electronic user groups/bulletin boards
  • Experience videos, internships, program visits
  • Expertise manuals, training programs
    (in-person, web-based)
  • Embedding programmatic systems-level technical
    assistance, organizational development, ongoing
    supervision/advocacy

29
Dissemination/Utilization Approaches
  • Patients and their caregivers
  • Exposure - popular media, community lectures,
    web-based consumer sites
  • Experience role models
  • Expertise manuals, videotapes and training
    programs (in-person, web-based)
  • Embedding - ongoing support meetings, feedback
    tools

30
Putting it altogether
  • Consider translation and dissemination issues at
    research planning and implementation stages
  • Clearly define the it is you want to translate
  • Clearly define the target audience
  • What impact do you want it to have? (short-term
    and over the long-run)
  • Assess the feasibility of translating it
  • Identify partners to help
  • Identify the early adopters
  • Specify aim of dissemination 4 Es

31
Questions?
  • Thank you!
  • Mary_Altpeter_at_unc.edu
  • 966-0499
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